Potassium hydrate: Causticum, as prepared by Hahnemann, is of somewhat uncertain nature and the modern liquor potassae is often dispensed as a substitute.
As it is difficult to distinguish, in the pathogenetic records, between purely experimental symptoms and those obtained from patients under treatment, no attempt will be made in this article to differentiate the two sets-pathogenetic and clinical. It will mainly consist of a record of the therapeutic uses of the drug. These are mostly well authenticated and reliable and the source of their inspiration will be ignored-though it may be assumed that in most cases they are based upon or deduced from the homoeopathic rule.
THE THERAPEUTIC USES OF CAUSTICUM reflect the effects of potassium salts in general, which are to produce great bodily weakness, physical and mental. These features tend to figure more or less prominently in all the cases for which causticum is useful. Many of these are the result of prolonged exhausting maladies or are due to fright, mental shock or excitement.
Nervous System.-Two forms of disorder come within the curative influence of causticum: (a) Irritative conditions- muscular twitchings and spasms, involving from single muscles of groups of muscles to those of a whole limb, or even ending in general convulsions. In this class must be included well-marked hyperaesthesia of special senses-hearing and touch. Meniere’s disease may be mentioned here.
Patients who are strongly affected by excitement or by any unusual circumstances, who “jump” or are startled by slight noises, or start in their sleep or without obvious cause, or certain children given to startings in their sleep, are likely candidates for causticum.
Concrete, named maladies or conditions in which such states are conspicuous are: hysteria; chorea, in cases where the movements continue even during sleep; epilepsy, or perhaps epileptiform seizures, said to be due to suppression of eruptions by local applications.
(b) Paretic conditions. These may be preceded for a short period by some of the irritative states just mentioned, to be quickly replaced by weakness going on to paralysis, motor or sensory. One of the commonest is unilateral paralysis of the facial nerve, due to prolonged exposure to a strong, cold dry wind, north or east, especially from driving in such a wind. If not quickly cured by aconite, causticum will usually complete recovery. The aetiological factor of exposure to driving winds, cold and dry, appears in other cases and such a cause should always lead to the consideration, inter alia, of causticum.
Stammering, regarded as a form of irregular paresis or inco-ordination, claims notice here as having been cured or improved by this remedy.
Other forms of paralysis or paretic conditions are
(a) those of the voice from disturbed innervation or inflammatory states, inco-ordination of action of the vocal cords; the muscles of the larynx and pharynx may be affected, allowing the passage of food into larynx or posterior nares, as if often the case in post-diphtherial paralysis ; or local paresis after acute exanthemata, enteric, typhus, measles, &c. The right side is more likely to be affected where causticum is required.
It also benefits or cures both retention and incontinence of urine in recent cases due to the shock of operation in the pelvic area; or it may improve the incontinence even of spinal cases, disease of the lateral columns or anterior cornu of the of the cord, ex. gr., in early infantile paralysis, or in prostatic cases. In these patients urination may be involuntary and the urine becomes turbid and strongly smelling. Incontinence on coughing or squeezing, &c., may suggest causticum, especially in women; and it is useful in children for nocturnal incontinence associated with constipation.
Ptosis of upper eyelids or diplopia of rheumatic origin or from exposure, again, may require this drug.
Paralysed feeling and tearing pain are felt in the right hand and wrist.
Pains..-The pains suggesting it are severe tearing pains, which appear to have settled in one limb or portion of the body, and which are due to one of the aforementioned causes-cold dry winds, fright, shock, chronic disease, &c. The “lightning pains” of tabes (locomotor ataxy) have been palliated by it.
The mental state of causticum patients must be taken into consideration. Besides the natural depression which may be expected in such maladies as have already been and will shortly be referred to, there are special features. There is a hopelessness as to the sufferer’s prospects-as to what will be the issue of his complaints, paretic, rheumatic or what not. The sense of impending disaster, personal or circumstantial, is strong upon him- fear of mental failure, of death, of misfortune to his family and friends, and of being alone in the dark and night. The equilibrium of a candidate for causticum is readily disturbed, he is easily excited and perturbed, easily made sufferings of other people. To an abnormal extent he is made worse by thinking upon his ailments (cham.)
From failing memory and absent-mindedness mistakes in speaking occur.
Rheumatic Conditions.-Causticum has a deservedly high reputation here,in cases where the fibrous tissues around joints, ligaments and tendons are more affected than the cartilage and synovial surfaces. Distortions and stiffness from thickening and shortening of tendons and even of the muscle tissue itself occur. Fixation of joints is thereby produced but not bony ankylosis or arthritic deposits.
Progressive stiffening and distortion of joints is accompanied with progressive weakness and increasing depression.
The “rheumatic” symptoms furnish one of the most important modalities of the drug-namely, intolerance of either extreme of temperature, one of the few remedies where this is well-defined. Furthermore, the patient is better in a relatively damp and mild climate; dry cold is his enemy. The intolerance of heat and cold is a “general” symptom, bearing on the whole patient; a local or “particular” symptom is that warm applications, especially moist warmth, relieve the pains- a contrasted but not incompatible condition in patients and a valuable indication for causticum.
Skin.-Causticum is a useful remedy in impetiginous eruptions of the face and head-thick, dried secretions like scabs or crusts on the back of the head, and for any ailments traceable to the suppression of such rashes by too vigorous external treatment. Facial paralysis is said to be on result of such suppression. The eruptions are characterized by soreness and rawness, and often by itching. This happens also in sound skin- calves or back-and at night in bed over the whole body. Fissures and cracks readily form in skin at the angles of the mouth, nose and corners of the eyes, also about the stiffened joints, the nipples and in the anal canal. With these are associated piles, which itch, burn, discharge freely and become hard and thickened, “Rawness and soreness” is a characteristic description. Old injuries, scars, &c., give pain or break down again; sour-smelling sweats occur, either at night in bed or from becoming heated or tired when walking. Causticum is also a remedy of great value for warts on the hands, fingers, face and elsewhere-dry, horny warts. This agent ranks next to thuja for patients with warts, although it was classed by Hahnemann as an anti-psoric rather than as an anti-sycotic remedy, showing that even his classification must here yield pride of place to the totality of symptoms.
Ears and Nose.-These mucous membranes feel the beneficial action of causticum in catarrhal states with thick, sticky discharges. The catarrh spreads up the Eustachian tube from the throat, causing noises and reverberations in the head; earache and deafness come on.
Old nasal catarrhs, with discharge and crusts similar to those on the scalp occur, with the same soreness. Nose-bleeding from the subjacent raw surfaces takes place.
Headaches may also result from this cause. Such of them as require causticum are throbbing headaches in the vertex, or pain and soreness in a small spot when touched, or a dull pain over the right eye. The scalp is likely to feel sore, with or without eruptions, and to have a tight sensation, as if it were contracted up like fibrous tissues around joints. Giddiness is a frequent accompaniment of the headaches, and it has these peculiarities: the patient may feel as if he were falling either to one side or forwards; it is especially noticed on certain kinds of movements, rising up from bed and on lying down again, also on stooping. In women it is liable to be worse during menstruation. It is usually less noticeable during the afternoon.
Eyes.-Besides the ptosis already referred to, causticum would be indicated in cases of diplopia from unequal action of the extrinsic ocular muscles, where there are black specks floating before the eyes, where large green or black spots are seen, or a green area remains after looking steadfastly at a white light. Ophthalmia, with ulceration of cornea, and thick, sticky discharge gluing the lids together, may be present, and lachrymation of acrid, burning tears.
Constipation,with ineffectual urging, is an indication for causticum and is often associated with the causticum headaches. The stools are tough and shining and are often passed more easily when standing. In men the straining to expel hard, knotty motions may cause the escape of prostatic fluid.
The chief spheres of action of causticum are the urinary, respiratory and nervous systems.
(1) Restlessness.-Cannot lie still or get into a comfortable position; must move about, but movement does not relieve (cham.).
(2) The subjective sensation of “rawness and soreness” is present in connection with many mucous and cutaneous surfaces or orifices.
(3) Causation.-Many maladies for which causticum is required acknowledge one or more of the following causes: (a) dry, cold winds; (b) chronic diseases; (c) long-standing grief and anxiety; (d) fatigue and mental strain from less of sleep and night watching; (e) sudden emotions, painful or pleasant.
(4) General sensitiveness to cold and draughts.
(5) Weakness.-In pronounced causticum cases the patient is weak and trembling, scarcely strong enough to move freely, and having no wish to move.
(6) Paresis.-The weakness extends to paretic or paralytic conditions of bladder, lower extremities, larynx, upper lids and other single parts, such as unilateral paralysis of the seventh nerve (cranial), and post-diphtheritic paralysis.
(7) Mind.-The patient is melancholy and full of forebodings, worse before menstruation; brain power, like muscular power, seems exhausted-is inattentive and disinclined for work. The memory is impaired.
(8) Incontinence or retention of urine from shock of operation or other; or in early spinal diseases; urine cannot be felt as it passes. Incontinence at night during sleep, or when coughing, sneezing, &c. Retention with urgent desire to micturate.
(9) Sour-smelling perspiration at night or when walking.
(10) Bruised feeling of parts lain upon or touched.
(11) Aphonia, with or without hoarseness, indistinct utterance.
(12) Rheumatic affections, with contractions around joints- fibrous,not bony.
(13) Right side more affected than left-head, testes, calf,facial paralysis. Left side-loin, hip.
(14) Cough, from tickling in paroxysms, with sore track down windpipe, relieved by sipping cold water.
(15) Warts, large, pedunculated, bleeding readily; or small, all over body, especially the face.
(16) The most suitable subjects for causticum are people with dark hair and dark or yellow complexion (bry.) who have broken down from chronic maladies.
Morning (sneezing, hoarseness and cough, also evenings); morning and evening (general); night (uneasiness); walking, eating (abdominal pain); warmth of bed (cough); dry weather, draught of cold air, coffee.
Lying down (stomach pain); sip of cold water (cough and gastric burning, &c.); in damp and wet weather, warmth of bed (rheumatism).